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300 Cardio Diabetes Medicine 2017

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cular events compared with placebo or no treatment coronary heart disease in subjects with type 2 diabetes and in nondiabetic
(relative risk [RR] 0.90, 95% CI 0.81-0.99). This was subjects with and without prior myocardial infarction. N Engl J Med. 1998
Jul 23;339(4):229–34.
however against an increased risk of major bleed-
ing. Aspirin did not significantly reduce the risk of 3. Diabetes and cardiovascular disease: Epidemiology, biological mecha-
nisms, treatment recommendations and future research [Internet]. [cited
any of the individual endpoints (MI, CHD, stroke, 2017 Sep 1]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/
CVD, or all-cause mortality). (9) The American diabe- PMC4600176/
tes association recommends that aspirin should be 4. Standards of medical care in diabetes--2015: summary of revisions. Dia-
considered for primary prevention in any patient with betes Care. 2015 Jan;38 Suppl:S4.
diabetes at increased cardiovascular risk (10-year 5. Selvin E, Marinopoulos S, Berkenblit G, Rami T, Brancati FL, Powe NR, et
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pertension, obesity, albuminuria, dyslipidemia, or a diabetes. Diabetol Metab Syndr. 2017 Apr 20;9:25.
family history of CHD). The ADA recognizes that the 7. Martín-Timón I, Sevillano-Collantes C, Segura-Galindo A, del Cañizo-Gó-
evidence to support this recommendation is weak. mez FJ. Type 2 diabetes and cardiovascular disease: Have all risk factors
2012 guidelines from the European Society of Cardi- the same strength? World J Diabetes. 2014 Aug 15;5(4):444–70.
ology, advise against the use of aspirin in individu- 8. Huxley R, Barzi F, Woodward M. Excess risk of fatal coronary heart dis-
als without cardiovascular or cerebrovascular disease ease associated with diabetes in men and women: meta-analysis of 37
due to the risk of major bleeding. The Indian national prospective cohort studies. BMJ. 2006 Jan 14;332(7533):73–8.
programme for prevention and control of diabetes, 9. Kunutsor SK, Seidu S, Khunti K. Aspirin for primary prevention of cardio-
Cardiovascular disease and stroke in its 2009 rec- vascular and all-cause mortality events in diabetes: updated meta-analysis
ommendation does not suggest offering aspirin as of randomized controlled trials. Diabet Med J Br Diabet Assoc. 2017
primary prophylaxis in patients with a cardiovascular Mar;34(3):316–27.
risk less than 30% due to lack of strong evidence 10. Bae JC. Diabetes Drugs and Cardiovascular Safety. Endocrinol Metab. 2016
to suggest the same . Therefore this decision on Jun;31(2):239–44.
primary prophylaxis must be taken by the treating 11. Commissioner O of the. Safety Alerts for Human Medical Products - Di-
physician keeping in mind the level of benefit that it abetes Medications Containing Saxagliptin and Alogliptin: Drug Safety
Communication - Risk of Heart Failure [Internet]. [cited 2017 Sep 2].
offers versus the risk of major bleeding it poses on Available from: https://www.fda.gov/Safety/MedWatch/SafetyInformation/
an individual basis. SafetyAlertsforHumanMedicalProducts/ucm494252.htm?source=govdeliv-
ery&utm_medium=email&utm_source=govdelivery%20(Accessed%20
4. Conclusion: The association of diabetes and car- on%20April%2012,%202016).
diovascular disease is therefore a major cause for
morbidity and mortality in patients with diabetes. The
risk factors that are related to this association need
careful understanding and are the principal targets of
approach in reducing the risk of cardiovascular dis-
ease. The role of aspirin in primary prophylaxis has
been debated and must be used after considering
the risk and benefit in the individual patient. The anti
diabetic drug armamentarium is rapidly expanding
and requires close examination of potential effects
on cardiac status. The physician must therefore have
an astute understanding of this quintessential rela-
tionship between diabetes mellitus, its therapy and
cardio-vascular disease for holistic management of
the diabetic patient.

Bibliography:
1. Diabetes Mellitus: A Major Risk Factor for Cardiovascular Disease: A Joint
Editorial Statement by the American Diabetes Association; the National
Heart, Lung, and Blood Institute; the Juvenile Diabetes Foundation In-
ternational; the National Institute of Diabetes and Digestive and Kidney
Diseases; and the American Heart Association. Circulation. 1999 Sep
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GCDC 2017